| NPI | 1992223457 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111NR0400X (Licence: CA 33931) |
| Additional Taxonomies | 111NS0005X Chiropractor, Sports Physician (Licence: CA 33931) |
| Enumeration Date | 2017-09-05 |
| Last Update Date | 2017-09-05 |